Nonoperative Management of Brachiocephalic Artery Dissection

A 68-year-old man presented with complaints of right-sided neck and chest pain with systolic blood pressure greater than 200 mm Hg but denied any recent blunt trauma or whiplash events. A computed tomography angiography demonstrated an acute dissection involving the origin of the right brachiocephalic artery that extended into the right common carotid and right subclavian arteries. The patient was neurologically intact and computed tomography angiography of the brain demonstrated a stable arachnoid cyst and a brain perfusion scan demonstrated homogenous perfusion. In the absence of strong indications for arch replacement, the patient was treated with warfarin and clopidogrel to prevent further thrombotic potentiation.